March 2014
Newsletter

The document is now up on Government of India’s web-site. All the formalities are over and the Amendment of the Narcotic Drugs and Psychotropic Substances (NDPS) Act of India can be now seen on the Government of India’s website.

The most relevant provisions are:

In section 4 of the Act, the addition of the words, “and for ensuring their medical and scientific use” is a very significant acknowledgement of the purpose of the amendment.

In section 2, the Amendment brings in the term, “Essential Narcotic Drugs” (END), which will include narcotic drugs notified by the Central Government for medical and scientific use.

In section 9, the Amendment transfers the powers for making rules regarding Essential Narcotic Drugs to the Government of India, so that the whole country will now have a uniform system pertaining to these essential opioid medicines.

The next step will be a notification by the Department of Revenue, enlisting the essential narcotic drugs, which should include morphine and other opioids used for pain relief, followed by the framing of “NDPS Rules”, which will delineate the procedure to be followed with respect to stocking, distribution, transport, possession and use of these drugs throughout the country.

The note available from the Lawyers’ Collective is descriptive of the changes and while recommending that anyone interested reads that page, we also use this opportunity to thank Tripti Tandon and everyone at Lawyers’ Collective, for playing a major role on this matter in addition to the government officials (particularly Mr Rajesh Nandan Srivastav, the Director of Narcotics Control in Revenue Department). And so many members of the palliative care community in India worked together and contributed in various ways; everyone of them certainly deserves appreciation for the selfless work and commitment.

Though it has taken a long time, we are all immensely happy that the Amendment spells out the purpose of the Act as inclusive of medical and scientific use and that the whole country will now have a uniform procedure through Central Rules, which will be fairly simple.

Thank you every one, for making this happen.

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More Media Attention

Critical Analysis of the NDPS Amendment : Detailed and Critical analysis of NDPS amendment from the International Drug Policy Consortium highlights the major role played by the Lawyers’ Collective. Indeed, we used to run to Ms Tripti Tandon of Lawyers’ Collective for all legal advice and support when working with the Department of Revenue of Government of India.

Special thanks to you, Lawyers’ Collective.

Pallium India’s Trivandrum Institute of Palliative Sciences (TIPS) has four teams going out on home visits every day. We badly needed a vehicle. State Bank of India came to our rescue.

In the background in the photograph, you will see a “Tavera” vehicle. In the foreground you see Dr M Sreenatha Sastry, Chief General Manager of State Bank of India, handing over the symbolic key to the Chairman of Pallium India, Dr M R Rajagopal. In addition to the vehicle, they also gave us Rs 8 Lakhs worth of equipments which were badly needed for our new inpatient facility. In his remarks on the occasion, Dr Sastry said that SBI certainly takes corporate social responsibility seriously.

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Pallium India is proud to announce the opening of a Pallium India collaborative project with the North East Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong. This project has already trained a doctor and a nurse – Dr Plabon and Ms Bilsheba – for six weeks at Trivandrum.

The palliative care clinic was inaugurated on 27 March, 2014. This project is funded jointly by Savitri Waney Trust, Farida and Yusuf Hamied Foundation and Bruce Davis Trust. Our congratulations to Dr P. Bhattacharya, who directs the project and Dr Ahangar, the Director of NEIGRIHMS.

CareVision India, a Non-Government Organization founded by Dr Sanghamitra Bora, will be starting its Free Home-Based Palliative Care Service for the poor and underprivileged patients of the society from 1st of April 2014. Pallium India collaborates with CareVision India in this project. The unbelievable suffering of patients in need of care in Kolkata will be partly taken care of by this initiative.

We hope this will be but a beginning. I am sure working with other organizations, including Eastern India Palliative Care program founded by Dr Sankha Mitra, we shall be able to do much more in the North-East India region.

Best Wishes, Dr Sanghamitra, and Thank You, kind donor, who does not wish to be named in these columns!

Project Hamrahi (Hamrahi in Hindi means ‘fellow traveller’) is a collaborative project between APLI (Australasian Palliative Link International) and Pallium India. In this, a doctor-nurse team from Australia / New Zealand builds a partnership with one palliative care link centre in India that Pallium India catalysed or works with. The visitors get the satisfaction of having made an enormous difference to a growing palliative care centre and maybe also learn a little bit about local customs and practices. The Indian centre, which often works with limited staff and limited capacity, gains by an annual visit of a week and support from the same team. So far, the program has been hugely successful.

One such team, Dr David Brumley, Ms Sarah Corfe and Dr Oliver Haisken worked with the palliative care team in Cachar Cancer Centre in Silchar, Assam. The palliative care team is led by the physician, Dr Iqbal Bahar, and by the palliative care nursing supervisor, Ms Sarita.

We asked Dr Ravi Kannan, the Director of the institute, what difference the Project Hamrahi made. Here is his reply:

They came and spent time with our nurses and doctors. For our nurses, I think the biggest advantage that Project Hamrahi offered was that it improved their self-esteem. That somebody from abroad is willing to come and consider spending time with them, talk to them, explain things to them, work with them, improved their self-esteem and confidence tremendously. The APLI team also pointed out how things could be changed, how the records can be maintained; they actually did an audit at the end of each visit. In the audit, we listed out things that we should achieve before the next visit. That really ensured that things get moving. They also brought material they could distribute, small things that could make incremental and significant progress. On their first visit, they gave us funds to train two nurses and we sent them to Trivandrum for training. This visit, they have offered to fund the training of two more nurses and we’re hoping to send them to Hyderabad.

By the way, the institution is also being developed as a “Pain-free” hospital under a Pallium India Collaborative Project directed by Ms Meg O’Brien – “Treat the Pain” funded by American Cancer Society. It has been hugely successful; I did a round of wards and almost none had more than score 2 pain. The one patient who did have severe pain was being attended to by the pain specialist as a pain emergency. Kudos to Dr Ravikannan, Dr Iqbal Bahar and Ms Sarita.

“Stringent and highly bureaucratic legislation, designed to prevent illegal diversion of medication, has led to patients in pain being unable to receive access to effective, affordable pain relief. A recent amendment to this legislation has just been approved by the Indian Government and more detailed information on these developments is available at the Pallium India website.”

The blog by Dr Claire Roques gives a visitor’s perspective of the annual conference of Indian Association of Palliative Care (IAPC) at and makes good reading.

Pallium India collaborated with Thanal Charitable Trust to create the first palliative care service in the Union Territory of Lakshadweep in 2013. It is progressing by leaps and bounds. They inaugurated their new Pain and Palliative care clinic in Kavaratti on 27-03-2014.

This facility which was constructed by a team of volunteers will run an Out Patient facility for Pain and Palliative care. It will also serve as the Head Office of the Lakshadweep Institute of Palliative Medicine. The foundation stone for a new Hospice (5 bed) facility was also laid on the occasion.

Dr Sankha Mitra submitted a project entitled “A Global Solution to Global Problems”, which won 2451 votes. The award includes a cash prize of Rs15,000 from Muthoot Pappachan Foundation, the corporate social responsibility arm of the Muthoot Pappachan Group and is given by National Skill Development Corporation (NSDC). The award was presented on 18 March 2014 at Gulmohar Hall, India Habitat Centre, New Delhi.

Mr Diederik Lohman of Human Rights Watch writes to inform us about the new recommendations for Older Persons by the Committee of Ministers of the Council of Ministers:Recommendation CM/Rec(2014)2

D. Palliative care

44. Member States should offer palliative care for older persons who suffer from a life-threatening or life-limiting illness to ensure their well-being and allow them to live and die with dignity.

45. Any older person who is in need of palliative care should be entitled to access it without undue delay, in a setting which is consistent with his or her needs and preferences, including at home and in long-term care settings.

WHO defines health as not just absence of disease, but also “complete physical, social and mental well-being”. Can a medical system run only by nurses and doctors achieve it?

In the children’s palliative care service in Government S.A.T Hospital at Trivandrum – started as a joint venture of Pallium India and the departments of Pediatrics and Pediatric Neurology – family members of children join hands with the staff and volunteers to plan and organize activities. True partnership in care!

“At the end of that day, I knelt beside her bed to say Good-bye. Lucy placed her hand on my forehead and said, ‘Bye, Lili, I am taking the best of you with me’… I felt sad, angry, helpless, and frustrated with a healthcare system and a culture that still does not embrace palliative care. It has to be pushed through the cracks, delivered bypassing the conventional medical practice…”

Read the article “Lucy” by Liliana De Lima, the Executive Director of the International Association for Hospice and Palliative Care (IAHPC), in the Journal of Palliative Medicine 17:2, 2014. She talks about meeting her dying childhood friend, now with advanced uterine cancer. Read how Lucy teaches Liliana a lesson in letting go, as she prepares to leave this world.

We hope this article makes you angry – angry enough to demand justice.

An item of news in the lay press suggested an “Exit Test” for MBBS graduates. After passing all the examinations involved in the MBBS course, this Exit Test would mean that they still would have to go through an examination process at the national level.

Dr Praveenlal Kuttichira, who is a Professor of Psychiatry and Principal, Govt Medical College, Thrissur, and Member of the Medical Council of India and a Member of the Governing Council of Kerala University of Health Sciences, writes about the various negative points associated with such a step.

PARTING SHOT

“…..he drew enough breath to whisper, “I hope I was a good father to you.” In that instant my heart stopped, and then, just as quickly, it swelled to fill my entire chest — fill my entire body, fill every moment I had lived up until that point — and I knew then exactly what was happening and finally came face-to-face with what it means to be loved and to love, and for that to be both everything and still not enough.

I couldn’t stop what was happening. I couldn’t fix it. I could barely understand it. I just knew I was loved and told him that I was lucky to have spent even a day — even an hour — with him”.

A touching reminder that in the end what matters most is to love and be loved – thank you Ms Katherine Pettus, for sharing the story with us.

Disclaimer: Information provided by Pallium India has been collected from different sources and though every effort has been made to ensure that it is up-to-date, its accuracy cannot be assured. Pallium India shall have no liability for any damages, loss, injury, or liability whatsoever suffered as a result of reliance on the information provided.